Fewer choices could once again be on the menu as Medicare patients shop for prescription coverage this fall.
The number of available stand-alone drug plans has declined in recent years, and this trend will continue in 2026. Most markets will still have several choices, but some options are becoming particularly rare for low-income subsidy buyers. And help may be harder to come by because some insurers no longer pay commissions to brokers for new business.
Buyers have from October 15 to December 7 to find new coverage that begins in January.
Some things to consider:
Regular Medicare, which most people qualify for after age 65, does not include prescription coverage, known as Part D. People must choose that separately.
About 23 million people with regular Medicare have this standalone coverage, according to the health care research nonprofit KFF.
About 34 million more people have Medicare Advantage plans, which are private versions of Medicare that often come with prescription coverage.
A typical buyer will be able to choose a standalone drug plan from eight to 12 options for 2026, according to KFF Medicare expert Juliette Cubanski. This represents a drop of 12 to 16 options in 2025.
Buyers had nearly 30 choices as recently as 2021, according to Gretchen Jacobson of the Commonwealth Fund.
Depending on the state, a range of one to four plans will be available premium-free to low-income subsidy-eligible individuals, according to KFF. Eight were available in 2021.
Some insurers are reducing their presence in standalone Part D plans, while Blue Cross-Blue Shield insurer Elevance is exiting the market entirely. Insurers and analysts who track the industry note that the Inflation Reduction Act, which will cap annual drug costs at $2,100 in 2026, is putting increased financial pressure on insurers. The same law now allows patients to spread the cost of prescriptions over the year.
Most markets will have several choices. But experts say Medicare Part D customers don’t like shopping, especially if they already have a plan that covers their medications. Finding affordable coverage for multiple prescriptions can be tricky.
“I think there’s a lot of inertia and, frankly, people may fear that if they change, their situation will end up getting worse,” Cubanski said.
More and more people are being pushed to go shopping. Nearly 11% of people with stand-alone prescription drug plans lost their plans in 2024, according to a study published recently in the Journal of the American Medical Association.
Before 2023, that figure was often less than 1%, said Dr. Christopher Cai, one of the researchers involved in the study.
Monthly premiums, or prices for coverage, will drop nearly 10% on average to $34.50, the Centers for Medicare and Medicaid Services announced last month.
At least one option with a premium of less than $20 exists in almost every part of the country, according to consulting firm Oliver Wyman.
Individual prices will vary widely, with premiums for the same plan varying by state, Cubanski noted.
But while plans may offer lower coverage prices, they may also increase deductibles or offer more limited lists of covered drugs, called formularies. Buyers should check these details.
Insurers will be allowed to increase their premiums by up to $50 per month for 2026, up from the $35 allowed this year. But Cubanski said only certain projects would reach that upper limit and not necessarily in all states.
Shoppers can use a federal government website to compare plan prices and coverage.
States also have a national health insurance program created specifically to help people with Medicare find coverage.
Consumers can help themselves by checking changes to their coverage and comparing it with other plans.
Shoppers should also ask whether their pharmacy is in the network covered by the plan they’re considering, said Jacobson, vice president of Commonwealth Medicare.
Some might also consider switching to Medicare Advantage plans with prescription coverage. But these plans may have more limited networks of covered doctors, which can pose a problem for people with fewer care choices in rural areas.
The listing window stretches for several weeks, but brokers say many people wait until the first week of December to make decisions, often after talking with family over holiday dinners.
This can create tight deadlines that make it more difficult to find help in early December.
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